MEDICARE: 360 INTEGRATED RECOVERY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1750078317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 INTEGRATED RECOVERY INC

Provider Business Mailing Address
First Line	:	546 W COLORADO ST UNIT 403
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91204-1360
Country	:	US
Telephone Number	:	949-701-9271
Fax Number	:

Provider Business Practice Location Address
First Line	:	3654 WRIGHTWOOD DR
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-3946
Country	:	US
Telephone Number	:	949-701-9271
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HALA AZIZ
Credential	:	MS
Telephone Number	:	949-701-9271

Provider Enumeration Date	:	04/21/2023
Last Update Date	:	08/16/2023

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Directions to “360 INTEGRATED RECOVERY INC ” Practice Location

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